Cigarette and e-cigarette tax effects on the oldest generation of smokers in the United States

Background and Objectives As cigarette smoking continues to decline among youth and young adults, smoking rates among older U.S. adults remain unchanged. Historically, cigarette and, more recently, e-cigarette tax policies influenced smoking behavior in younger smokers. This study examined how older smokers respond to tax changes to inform public health strategies. Research Design and Methods Our data combined a panel of state cigarette and standardized e-cigarette tax rates with individual-level survey microdata. Our sample included adults aged ≥65, with and without a history of smoking. We estimated two-way fixed-effects population-weighted regression models of current smoking and past-year quit attempts. Exploratory subgroup analyses tested for heterogeneity by education and income level. Results Among 3,117,382 adults, 48% had a history of smoking; of whom 18% currently smoked. A $1.00 cigarette tax increase was associated with current smoking: est. = -0.56 percentage points (pp) (CI: -0.85, -0.27). A $0.10 increase in e-cigarette tax (open) was associated with current smoking (+0.28 pp; CI: 0.01, 0.55). Approaching tax parity by one dollar was associated with a 0.48-pp (CI: 0.20, 0.76) increase in current smoking. While varied by socioeconomic status, there was no association between cigarette/e-cigarette taxes and quit attempts. Discussion and Implications For older U.S. adults, cigarette taxes were associated with lower smoking, whereas e-cigarette taxes were associated with higher smoking. The type of e-cigarette tax appears important for tobacco control in older smokers. Policies increasing the relative cost of e-cigarettes may perpetuate smoking rates in older populations at the highest risk of smoking-related harm.